摘要
目的探讨左炔诺孕酮宫内缓释系统（LNG-IUS）治疗症状性子宫腺肌病[重度痛经和（或）经量过多]过程中计划外取出和脱落的情况。方法北京协和医院妇产科2006年12月至2014年12月对超声诊断为子宫腺肌病的重度痛经和（或）经量过多患者给予LNG-IUS治疗,在放置前后评估患者的痛经症状、疼痛评分、出血评分、生化指标、体格参数、月经模式以及不良反应,分析LNG-IUS计划外取出和脱落情况及其相关因素。结果符合入选标准的病例总计1100例。LNG-IUS放置60个月的累积取出率和脱落率分别为9%和16%,66%的取出和69%的脱落发生在放置12个月以内。LNG-IUS计划外取出的常见原因是月经模式改变或不良反应（75.0%）以及感觉治疗效果不佳（55.8%）。回归分析发现,腹腔镜术中放置LNG-IUS能够降低计划外取出（OR=0.63,95%CI 0.40～0.99,P=0.040）,而放置前应用促性腺激素释放激素激动剂（Gn RH-a）和经量过多的症状是放置后脱落的相关因素（OR分别为0.50和1.71,95%CI分别为0.34～0.74和1.20～2.43,P值分别为〈0.001和0.003）。取出和脱落LNG-IUS与治疗结局、月经模式变化以及实际的不良反应均无显著相关。结论大部分LNG-IUS的取出和脱落情况发生在放置后12个月内。妇科腹腔镜术中放置LNG-IUS能够减少患者的计划外取出。经量过多的子宫腺肌病患者放置LNG-IUS后脱落率显著增加,放置前应用Gn RH-a可以降低脱落率。取出和脱落与治疗结局、月经模式变化以及不良反应等均无关。
Objective To investigate the prevalence of unplanned taking-out and spontaneously expulsion of levonorgestrel-releasing intrauterine system（LNG-IUS） and related factors during the treatment of symptomatic adenomyosis（severe dysmenorrhea and/or menorrhea） in a prospective cohort study.Methods From December,2006 to December,2014,patients with symptomatic adenomyosis diagnosed by transvaginal ultrasound in Peking Union Medical College Hospital were given the treatment of LNG-IUS.Before and after placement of LNG-IUS,all the parameters were recorded,including symptoms and scores of dysmenorrhea,menstruation scores,biochemical indicators,physical parameters,menstruation patterns and adverse effects.The prevalence of unplanned taking-out and expulsion of LNG-IUS and dependent factors were analyzed.Results There were 1100 cases that met inclusion criteria.In 60 months after placement of LNG-IUS,the accumulative ratios of taking-out and expulsion were 9% and 16% respectively,66% taking-out and 69% expulsion happened in 12 months.Most common reasons reported by taking-out patient were changes of menstruation patterns or adverse effects（75.0%）,and feeling unsatisfied about the treatment effects（55.8%）.Placement during gynecological laparoscopies could reduce taking-out of LNG-IUS（OR 0.63,95% CI 0.40~0.99,P=0.040）.Gn RH-a treatment before placement and symptom of menorrhea were independent factors predicting expulsion of LNG-IUS（OR were 0.50 and 1.71,95%CI were 0.34~0.74 and 1.20~2.43,P values were 0.001 and 0.003）.Prevalence of taking-out and expulsion had no relation with treatment effects,changes of menstruation patterns or actual adverse effects.Conclusion Most taking-out and expulsion of LNG-IUS happens in 12 months after placement.Placement during gynecological laparoscopies reduces takingout of LNG-IUS.Patients of menorrhea have higher probability of expulsion,while Gn RH-a treatment before placement can decrease rate of expulsion.Taking-out or expulsion is not related to treatment effects,changes of menstruation patterns or adverse effects.
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2016年第11期1088-1092,共5页
Chinese Journal of Practical Gynecology and Obstetrics
